Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHA333 > Wk 29 - ADHD in practice > Flashcards

Wk 29 - ADHD in practice Flashcards

1
Q

What is ADHD?

A

Developmental condition of inattention + distractibility, w/ or w/o accompanying hyperactivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 3 basic forms of ADHD?

A
  • Predominantly inattentive
  • Predominantly hyperactive/impulsive
  • Combined
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which gender does ADHD most affect?

A

Boys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When is ADHD normally diagnosed?

A

3-7yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the primary symptoms ADHD?

A
  • Inattentive
  • Hyperactive
  • Impulsive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Give examples of inattentive

A
  • Short attention span
  • Easily distracted
  • Forgetful
  • Unable to conc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Give examples of hyperactivity

A
  • Unable to sit still
  • Fidgeting
  • Excessive movement + talking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Give examples of impulsiveness

A
  • Unable to wait turn
  • Acting w/o thinking
  • Interrupting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Give examples of when ADHD is most common

A
  • Preterm born
  • Looked-after children
  • Family w/ ADHD
  • Neurodevelopmental disorders
  • Acquired brain injury
  • Known to youth justice system
  • History of substance abuse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Give examples of related disorders that can occur alongside ADHD

A
  • Anxiety
  • Learning difficulties
  • Tourettes
  • Epilepsy
  • Depression
  • ODD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is covered in primary care?

A
  • Explore presenting problems
  • Assess social + educational impact
  • Waiting upto 10 wks
  • Parent group based ADHD focused support
  • Lifestyle advice + regular exercise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Who carries out formal diagnosis + treatment of ADHD?

A

Specialist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Outline the NICE guidelines for the management of ADHD in pre-school children

A
  • Drugs not recommended
  • Parent training/ed programme
  • Specialist advice where ineffective
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Outline the NICE guidelines for the management of ADHD in school-age + young people

A
  • Drugs not 1st line
  • Parent training/ed programme +/- CBT + social skills training
  • Reserve drugs for when persistent impairment after env mods
  • Methylphenidate 1st line
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Outline the NICE guidelines for the management of ADHD in adults

A
  • Env mod
  • Drug treatment (methylphenidate/lisdexamfetamine) offered if ADHD symptoms cause sig impairment
  • Non-pharm treatment considered alongside
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What must be present when diagnosing?

A
  • Core symptoms of hyperactivity, inattention + impulsivity
  • Associated w/ least moderate psychological, social + educational or occupational impairment based on interview + obvs in multiple settings
  • Pervasive, occuring in 2 settings: social, familial, educational + occupational
  • Present for at least 6 months
17
Q

Outline the drug therapy in order of lines

A

1st : methylphenidate

2nd: Lisdexamfetamine
3rd: Dexamfetamine

18
Q

What is used to reduce drug misuse?

A

Lisdexamfetamine less abuse than dexamfetamine

19
Q

Methylphenidate

A
  • CD sched 2
  • Inc intrasynaptic conc of dopamine + noradrenaline in frontal cortex
  • Piperidine class
  • Structure similar to amphetamine though less potent, pharmacological effect close to cocaine
20
Q

What are the common adverse effects of methylphenidate?

A
  • Insomnia
  • Headache
  • Dec appetite
  • Tachycardia, minor inc BP
  • Growth affected so monitor height + weight
  • Sudden death syndrome
  • Enhanced by alcohol
  • Affect ability to drive
21
Q

What are the monitoring points of methylphenidate?

A

Initiation + every 6 months:

  • Pulse, BP
  • Psychiatric symptoms
  • Appetite, weight + height
22
Q

How is methylphenidate intiated?

A
  • CD requirement
  • Low dose + titrate over 4-6wks until dose optimisation achieved
  • Avoid abrupt w/drawal
  • Can mix w/ food
  • Prescribe by brand
23
Q

What are the driving advice for amphetamines?

A
  • Don’t drive if drowsy or dizzy or unable to conc

- Keep prescription in car as it is an offence to drive w/ more than specified amount in body

24
Q

Dexamfetamine

A
  • Sched 2
  • Block uptake of dopamine + noradrenaline via dopamine transporter also releases dop + NA into extraneuronal space
  • More potent than methylphenidate
  • More misuse
  • 6.8 elimination tf twice dosing = sufficient
25
Q

Lisdexamfetamine

A
  • Prodrug of dexamfetamine
  • Sched 2
  • Long lasting (13hrs)
  • Less rebound symptoms
  • Less abuse potential
  • Improved adherence
26
Q

Atomoxetine (strattera)

A

For when abuse = problem

27
Q

What are the side effects of atomoxetine?

A
  • Abdominal pain, dec appetite, nausea, irritability, mood swings
  • Inc HR + BP
  • Prolongs QT interval
  • Hepatic disorders: recognise abdominal pain, darkening urine + jaundice
  • Suicidal ideation
28
Q

Outline the MHRA warning for atomoxetine

A
  • CI: severe cardiovascular or cerebrovascular disorders
  • Assess patient prior for cardiac disease
  • Record HR + BP before treatment, after dose change then every 6 months
  • Urgent referral to cardiac specialist
29
Q

What must be monitored?

A

Prior to initiation + every 3-6 months:

  • Pulse + after dose change
  • BP + after dose change
  • Weight
  • Height in children + young people (dexamphetamine)
  • Sleep disturbances
  • Erectile dysfunction (atomoxetine)
  • CDV assessment: refer to cardiology if cardiac history/risk
  • Seizure freq
30
Q

Give examples of what to do if weight loss is an issue

A
  • Take med w/ or after food
  • Additional snackers early morning or late eve when stimulant effect wear off
  • Seek dietary advice
  • Inc consumption of high calorie food w/ good nutritional value
  • Change med
31
Q

What are the key interactions of methylphenidate?

A
  • Anticoagulants
  • Carbamazepine
  • MAOIs
  • Phenytoin
  • SSRIs
  • TCAs
  • Alcohol
32
Q

What are the key interactions of amphetamines?

A
  • Moclobemide
  • MAOIs
  • Rasagiline
  • Atomoxetine
  • TCAs
  • SSRIs
  • HIV protease inhibitors
33
Q

What are the key interactions of atomoxetine?

A
  • MAOIs
  • Drugs that prolong QT interval
  • Terbinafine

PHA333 (35 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions